Dural arteriovenous fistula mimicking ischemic stroke presented intracranial hemorrhage after thrombolysis: case report

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  • 急性期脳卒中様の発症形式を示しrt-PA静注療法後に脳出血を来した硬膜動静脈瘻の1例

Abstract

<p>A 74-year-old man with no medical history was admitted to the emergency department because of sudden sensory aphasia and dysarthria. Diffusion-weighted imaging (DWI) showed a slight high-intensity signal in the left temporal lobe. Magnetic resonance angiography did not detect large vessel occlusion. Perfusion image showed no ischemic core by CBF, and the time to maximum (Tmax) extended lesion was in the same area as the DWI slightly high-intensity area. The patient received intravenous thrombolysis for acute ischemic stroke and had intracranial hemorrhage the following day. We diagnosed Borden type 3 transverse-sigmoid sinus dural arteriovenous fistula (dAVF) by DSA and transarterial embolization was performed. Nonhemorrhagic dAVF mimicking stroke is rare and could cause hemorrhagic events by intravenous thrombolysis; therefore, we should focus on the differential diagnosis. Here, we determined the abnormal perfusion pattern on the temporal lobe retrospectively, the coexistence of hypoperfusion and hyperperfusion. The paradoxical finding suggests that the symptom was nonconvulsive status epilepticus, and ictal hyperperfusion existed in the hypoperfusion area due to venous congestion with dAVF.</p>

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